Family medicine wrap up: tips to be successful on this rotation

My tips to help you rock the family med rotation/shelf!

It’s Christmas Eve and this is actually the last thing I want to be thinking about, but I know the longer I wait, eventually I’ll forget all of my pearls. So lets get to it shall we…

In terms of the rotation itself, if you enjoy clinic, you’ll thrive in Family medicine. For the most part, that’s the gist of it. On my rotation, we also did hospitalist work each morning, but that’s not a common experience. (1) I would use every patient that comes in for routine visit to help you memorize the guidelines set by the USPSTF. Those are super important to have memorized and get you easy points on the shelf exam. Knowing the guidelines can also help you shine clinically, as they are often pimp questions, and can improve your assessment and plan. (2) Another tip, always pay attention to what the patient is allergic to. There’s a lot of go-to medications for different things and you don’t want to be too quick to suggest something harmful. (3) If you don’t have access to the electronic records at your site, you can still show initiative if there are paper charts available. (4) Be willing to ask the nurses to help sharpen any ancillary skills you want to work on. (5) As soon as you see/hear something that you don’t know–look it up. You’ll remember it better when you learn it in the context of a patient vs. reading about it later in case files.

Outside of the rotation, I was sacrificing time for my family trying to be a good sister, daughter, and auntie. My self care went out of the window–again. I probably went to the gym twice, if that. I really let stress eat me, literally–I lost weight by the end of the rotation. Third year is just so much harder for me to fit everything in! And this rotation with this 30 minute commute really sucked my time away from me! One thing I was able to do was continue to wash/co-wash my hair regularly each week, so I’m proud of that, because that is a time-consuming process.

Shelf Exam (end of rotation exam)

First of all there is no magic formula to the Family medicine shelf exam. I never felt like I was ready to take it. There are recommended resources out there but even still.. it’s just a wide open exam that throws everything at you. I began the week before (I was on palliative care) with reading the Ambulatory Medicine section of Step up to Medicine and doing PreTest Questions. Once the rotation started, I was doing AAFP Q’s during the clinic day between patients and PreTest Q’s + OME videos + Case Files at night (I just watched whatever videos I felt were relevant). I took bulleted notes on the CF cases as I read them. I finished PT in 2 weeks and didn’t redo my missed questions until the weekend before the exam. I switched focus to AAFP Q’s and I finished them and CF a week before my exam. I did them all through the day, through my lunch break, and at home after work along with more OME videos. I read 2-3 CF cases each night on average. I took the 2 practice NBME’s available which were pretty difficult and random (like the actual exam). I didn’t meet the threshold I needed on either one of them so that just emphasized me not feeling ready. I think my actual exam had a lot more preventative medicine on it compared to the practice tests that at some points made me feel like I was on internal medicine. I did see practice NBME Questions on my exam. Anywho, the week of the exam I reread the ambulatory medicine section, studied my notes from OME and CF, did more repeat AAFP Questions, did the 125 UVA questions (highly recommend) and searched SDN to make sure I wasn’t forgetting anything lol. There was nothing else I could do but pray and go in and do my best then continue to live my life.

I’d say my favorite resources were Case Files as a text and the PreTest questions. These two taught me the most information. I thought PT was more relevant to the shelf compared to AAFP (but getting outdated so watch out for changes in management). The AAFP Questions are cool too, but it’s not presented in a way where you can review the ones you missed, so you aren’t able to reinforce as much. I felt like I was just doing them just trying to finish them. And I didn’t have the patience to be taking notes on each question, only ones that really stumped me.

All in all, despite the nasty shelf exam, I loved family medicine, and I plan to declare it as my chosen specialty! It’s really amazing what you are able to do for people in this field.

PS. NOLA was a BLAST and a much needed trip that made me forget about all of my troubles. Wishing everyone a Merry Christmas!! I hope you enjoy your time with your family/friends. Our savior is born! Have a wonderful week!


ije long logo BLK

What you need to know about the OBGYN rotation

My pearls to help you be successful on the OBGYN clerkship & Shelf exam

Day 1: Approach the OBGYN physician with caution

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Most docs in the OB field are generalized to be “catty”, which of course isn’t true everywhere. But if you think about it—the long hours, being on call, constantly feeling like you’re on demand–you can imagine how that can wear on your attitude some days. So, careful as you come in with your beaming smile and radiant energy because you may not be met with the same thing. You’re likely coming off of a full nights sleep while your doc or resident was on call last night. So, use your social cues and gage the situation. Look for ways to help your people out or help the staff to do anything that makes the day run smoother. The staff will love you, and your attending will notice how much they love you.

It’s not all about the deliveries!

The first thing people say to me when I tell them I’m on OBGYN is so you’re delivering lots of babies huh? Of course delivering babies is a big part of the field (especially financially), but as a student if you go into the rotation thinking you’re only going to be popping babies out left and right, you’ll be highly disappointed. And there is so much to learn in those 12-24 hours leading up to the delivery–managing the patients labor, tracking the rate of cervical dilations, monitoring the status of the fetus, making sure mom is comfortable and gets her epidural on time, etc. The birth itself is a bloody climax to it all. So whenever you spend your time on L&D, I advise you to work closely with & learn from the nurses (or possibly junior residents) who are likely the ones keeping a close eye on everything. In my experience working in a smaller town, the nurses manage the patients all the way until about 60 seconds before the baby is ready to see the world. So I really gained a TON of knowledge and clinical experience by following patients with the nurses, much of which helped me on the Shelf exam. And to answer the question, yes I caught my fair share of babies.

You need to know ASEPSIS

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OBGYN is a surgical specialty and you spend quite a bit of your time in the operating room (at least I did). Pay special attention to your ASEPSIS training and if you aren’t getting it right before the rotation, watch some YouTube videos to help you refresh. Save yourself the embarrassment & potential scolding depending on where you rotate. I think the most common way you’d mess up (from personal experience and from what I’ve been told) is moving the surgical light with your sterile hands, so be extra careful there. Luckily I rotated at a site where the staff and doctors were chill and didn’t take pleasure in making med students cry, so when I messed up it wasn’t the end of the world.

On surgery days, learn as much about the patients as possible

Watching/assisting with procedures is awesome, but unfortunately won’t get you very far in the numbers game as a third year medical student. Take time to read each patients chart before the surgery in order to understand how they got to this point. Then go ask them questions if you can before they get all doped up. How old are they? What were their major symptoms? What things did they try before hand? If you’re doing an operative laparoscopy (op-lap), think about some things you might see based on the patients symptoms. Especially cases like dilation & curettages, LEEP and cone biopsies–learning about the patients getting these procedures can help you in your studies when a clinical vignette is asking you about the infamous “next step in management.”

SHELF advice–The name of the game is management and risk factors

What is the diagnosis? What is the next step in management? What is the greatest risk factor for this patients condition? are a few of the most common question stems you will encounter in your shelf prep. So start early nailing these things down as you study different conditions. If I could go back, I would have kept a few sheets of paper where I drew out flow charts for the management of different conditions. It gets so confusing when you follow different protocol based on age or weeks gestation or stage of cancer or grade of lesion. I found myself second guessing a lot of those types of things, even on my exam.

 math study learning exam studying GIFThe resources I used were the Beckman’s textbook, Online MedEd, UWise, UWorld, PreTest, and I read some of Case Files in the last weeks. Each of those resources were solid, but honestly PreTest really wasn’t doing it for me like it did during Pediatrics. Like in Peds, I watched all of the OME videos up front and took digital notes on them as my foundation. As I did questions and learned more, I added those notes into the structure I already had. Our school had a reading schedule for us to get through the Beckman’s text along with the associated APGO YouTube videos and UWise quizzes. I was able to keep up with that consistently. I did PreTest in the first 3 weeks by waking up early in the morning or doing questions at night when I finished the readings and Uwise. But like I sad, it’s really not something to be pressed about. I did UWorld in the 4th and 5th week and did NBMEs/UWise comprehensive exams in the last week. Lastly, you want to always have something on you to study at all times. There is down time on L&D and in between surgeries that you can use to get some of your work done, especially if you have long hours.

Nearing the end of the rotation, I had this unsettling feeling in me that no matter how much I studied, I would still be iffy on those management questions. I just felt like there was no way for me to just memorize it all (I’m horrible at memorizing things if you didn’t know). I could only really remember the things that related to patients that I worked with. That’s why I said if I could go back I’d have created something as I went and used that to review/memorize in crunch time. But hey, I did my best, which is all I can ask of myself, so we’ll see how those results come out!

I hope this is helpful to someone. If you’ve been through it and have other things to add about OBGYN, feel free to drop them in the comments!

Also, S U B S C R I B E !

Experience is the best teacher

Peds experience, my Shelf prep, and what’s next for me

6 weeks of Pediatrics blew by so fast! I learned so much and really put myself out there. Clinically, it was fantastic because I had a perfect blend of outpatient (2 weeks) and inpatient (2 weeks) experience along with nursery (1 week) and subspecialty (Heme-Onc, 1 week). Personally though, I’ve been feeling more unlike myself. Once inpatient started, I lost touch with just about everything. My days were on average from 6:30-5 and I’d be pretty pooped by the end and wanted to use the little energy I had to study for my Shelf exam*. I felt like I couldn’t even sacrifice the time to go to the gym, which is so unlike me! The gym clothes I kept in the car eventually got thrown to the back seat so I wouldn’t have to think about them lol. Eventually I hit a low point of true exhaustion, which was inevitable honestly with my level of sleep deprivation. I feel like because this was my first rotation and first Shelf exam, I just had to give it my all. And it’s in a primary care specialty (and I want to do PC) so I just wanted to shine. Even when I started newborn nursery I had so much more time on my hands, but I still spent it studying because at that point I was 2 weeks out from the Shelf and I was going to be in Miami the weekend before so I felt pressure to really grind it out to keep the study guilt away. And by the grace of God I made it through! And now I’m ready to start my OB-GYN rotation in rural Tifton, GA. I’ll get into more logistic detail of my Peds rotation at the end (and my Shelf prep!), really just for other med students who wanna know. I won’t be mad if you just scroll down to the end.

One highlight of Peds was in the nursery helping a mom breastfeed her newborn after I had spent some time with our lactation consultant. It was just really cool to translate those techniques I had learned to another mom. Another highlight was seeing a patient I took care of in outpatient my first week again in the Heme-onc clinic in my last week! It was actually the little girl I mentioned in my last post. A low point was getting pimped** on diabetes my first week on inpatient and not being able to come up with the answers. I felt so embarrassed because I remember it was something simple but I was just so nervous I couldn’t think, I could just stand there and sweat lol. I bounced back though so issok! Another notable moment that was a high and low was putting in an NG (nasogastric) tube in a kid. It was a cool “procedure” to do, but the kid was so miserable that I was pretty traumatized. I’ll probably never forget his screaming and the look from his parents like “wtf are y’all doing to my son.”

Finding balance in third year is so much different from first and second year. Whoever has the secret needs to let ya girl know because I’m still trying to figure it out! It’s so much easier when you just have 4 hours of lecture material to get through and you can control your schedule however you want. I was just a full time student. Now I feel like I have TWO full time jobs! I really love working with patients all day and not being in class; thinking about them gets me out of bed in the morning. And then I come home and everything shifts and it’s like I have to start my night job *eye rolling emoji*. But I will say that I definitely learned from my experience and will make a conscious effort this next rotation to be more balanced so I can be just as happy at home as I am at work. Actually, that in itself will be its own challenge because the house I’m going to be living in is basically from the 1800s (exaggerating, but its supposedly old and dingy). I’m just going down there with an open mind and my usual positive attitude and we’ll see how it goes. Luckily I have Verizon, so even though I’ll be in the middle of nowhere, at least I know I’ll have service! I’m excited though, to get out of my comfort zone and embrace a totally different setting than I’m used to. That’s really the reason I chose (yes I did this to myself) to go rural for a couple of my rotations.

Back to Peds though: I just wanted to break down the day-to-day and also my Shelf prep for other students with Peds in their future or wanting to compare (and also for me to refer back to later tbh). I started with outpatient, which ran just like any clinic. I worked with different preceptors each morning and afternoon, which had it’s pros and cons, both having to do with learning different styles and preferences. We saw patients ourselves and had to write the notes on each patient–again, pros and cons. It’s a great skill to learn, but you wanna also see more patients so you can learn more. Inpatient was rough with the 6:30am handoff from the night team. Afterwards you had a sliver of time to research any new admissions you picked up and go pre-round on your patients before morning report and rounds began soon after. The first week rounds took about 2-2.5 hours. The second week it was 3-3.5 hours just about everyday (comfortable shoes are a must!). We had different attendings each week, so more different styles. I probably learned the most shelf-wise from inpatient because of the exposure to so many complex patients. Newborn nursery was about the same–7am to research patients and do pre rounds. I became numb to babies crying once you un-swaddle them to do your exam. You also learn to be gentle with your language because moms don’t want to hear anything that sounds even remotely negative about their baby. Lastly, Heme-Onc clinic ran like outpatient primary care did. I saw patients on my own then with the attending. You learn a lot about chemotherapy regimens and anemias. There are sad cases and also really cool survivors stories too. One day I sat with my attending as she cried for one of her patients. It takes a special person to work with that population of kids. Overall though, it was a pretty dope experience.

I started Shelf studying on day 1 with Online Med Ed videos, which I created my own notes on, and a chunk of Pre-Test questions daily. There’s ~900 Qs to get through between PT and UWorld so I pushed myself to get through them all + my missed questions, which I was able to do. I added Q bank notes to the relevant OME sections. Once I started realizing what my weak areas were, I supplemented with those chapters in BRS. I originally wanted to read the whole BRS but for me that was just unrealistic. I’m a reader, but I need to read something multiple times, so I wouldn’t have fully benefited from reading that whole book, especially if I started in early in the rotation. You gotta know yourself. The notes I had by the end were pretty golden. I went through the Emma Holiday review twice in the week leading up to the shelf (one time was on a drive from Atl). In the end I definitely felt prepared going into the exam. A lot of questions still stumped me and threw me for a loop, which I expected from speaking to other 4th years, but I definitely did my best and really put my all into preparing, so we’ll see how it turns out!

Ok I’m done rambling now! Hopefully I figure this whole balance thing out soon so I don’t have this much time between posts. I’m still human though, still learning and growing, Experience is the best teacher..

Much love & thanks for supporting me. Next stop, Tifton!

The LORD is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge

– Psalm 18:2

*National exam students take at the end of each rotation. At our school, we have to make a certain score cut off to be eligible for an A in the rotation.
**being asked questions on the spot